tbuckley/cabot-search huggingface dataset:
Inflammatory bowel disease and coexistence of neuroendocrine neoplasms: A review of the literature.
Authors: Imad Karam, Nikolaos Trikalinos
Journal: Journal of Clinical Oncology (2022)

e16206 Background: Inflammatory bowel disease (IBS) has been associated with colorectal adenocarcinoma, but its co-occurrence, causal or coincidental, with the more rare neuroendocrine tumor (NET) histology is not well understood.The incidence of carcinoid tumors has been increasing and chronic inflammation can be theoretically associated with carcinogenesis, including the development of carcinoid tumors. We aim to describe the reported literature on patients with IBS who also developed NET and summarize the characteristic findings reported in eachcase. Methods: This is a descriptive retrospective review of all cases of patients with IBD who developed NET reported in literature. We performed a Pubmed search with select keywords for IBS and NET, including ‘Inflammatory bowel disease’, ‘Ulcerative colitis’, ‘Crohn’s disease, and ‘Neuroendocrine Tumors’, or ‘carcinoid’. Extracted information included age, gender, inflammatory bowel disease type, number of years with IBD, treatment received for IBD, tumor site, indication for surgery, the extent of IBD, coexisting tumors, pathological findings, distant metastasis at diagnosis, and survival. Results: Out of 539 articles we identified 87 cases reports between 1970 and 2021. The mean age of patients was 43.61 years. IBS included ulcerative colitis in 46% (40) and Crohn’s disease in 51.7% (45) of patients. The male to female ratio was 1.7:1. The median number of years with IBS before diagnosis of NET was 12.5 years.Of the patients, 36.6% percent (31) were reported to receive treatment for IBS; of these 61.3%(19) were treated with steroids, 42% (13)mesalamine, 29%(9) azathioprine, 12.9% (4) infliximab, 6.4%(2) adalimumab, 3.2%(1) methotrexate, and 3.2% (1) mercaptopurine. Three patients 3.4% (3) initially underwent colectomy with ileostomy. IBS was diffuse in 20.7%(18) of the cases. The ileum was involved in a total of 35.6% (31) and the rectum in 4.6%(4). A mass was found upon regular screening imaging or regular surveillance in 8%(7) of the cases. The NET site was in the rectum in 20.7%(18), in the ileum 19.5%(17), and in the appendix in 19.5%(17). The indication for surgical intervention was due to refractory symptoms in 19.5% (7) of the cases and obstruction in 12.6%(11). About 35.6%(31) of NET cases were reported as well-differentiated, 5.7% (5) as poorly differentiated. Grade was high in 3.4% (3) and low in 5.7%(5) of the cases. Metastasis was reported to lymph nodes in 11.5% (10) and the liver in 5.7%(5). 13.8%(12) had a coexisting adenocarcinoma and 11.5%(10) died from NET. Conclusions: Most NETs in patients with IBS are in younger patients with non-diffuse disease, take a considerable time to develop, are low grade and localize in ileum, appendix and rectum. It is important to consider NET in patients with IBD who develop refractory or obstructive symptoms, especially when considering imaging / endoscopies to assess IBS status and response.
Pathological, functional and oncological best-case scenarios after robot-assisted radical prostatectomy – can we improve quality of life?
Authors: T. Karagiotis, J.H. Witt, M.A. Mendrek, C. Wagner, A. Schuette, N. Liakos, P. Rachubinski, K. Urbanova, M. Oelke, S-R. Leyh-Bannurah
Journal: European Urology (2022)
Discordant genomic correlates of PD-L1 expression in lung adenocarcinoma among multiple cohorts using dissimilar PD-L1 testing techniques.
Authors: Lijie Wang, Siyao Liu
Journal: Journal of Clinical Oncology (2022)

e20526 Background: Programmed death-ligand 1 (PD-L1) is a crucial biomarker predicting efficacious treatment of immune checkpoint inhibitors (ICIs). Previous studies identified distinct staining utility among multiple PD-L1 antibodies, however, whether the genomic correlate of stained PD-L1 is also impacted by different testing assays is largely unknown. Methods: Here, we analyzed 873 lung adenocarcinoma (LUAD) samples by the FDA-approved SP263 and 22C3 antibodies, and discovered that TP53, KRAS, MET, and ALK alterations associated with high SP263/22C3-PD-L1 expression, while EGFR and ERBB2 aberrations linked to SP263/22C3-PD-L1 negativity. Results: We retrieved the data of 873 LUAD patients whose PD-L1 (SP263/22C3) and mutational data. The SP263/22C3-PD-L1 expression was significantly correlated with tumor mutational burden and was greater in metastatic lymph node than lung lesion and distal metastasis. Furthermore, TP53, MET, ALK, KRAS alterations were associated with higher SP263/22C3-PD-L1 expression, while EGFR and ERBB2 alterations were linked to SP263/22C3-PD-L1 negativity. In the TCGA database lacking fusion data except for ALK and using reverse phase protein arrays (RPPA) for quantifying PD-L1 expression, STK11 mutation exhibited negative correlation with PD-L1 mRNA (p &lt; 0.001), but not the RPPA-PD-L1 protein-level expression (p &gt; 0.10), while samples with ALK fusion showed a tendency of higher RPPA-PD-L1 (p = 0.088). Moreover, in the OAK trial providing data of single nucleotide variation and using SP142 (Ventana, Tucson, AZ) assay evaluating both tumor and immune cells, weak correlation between STK11 mutation and SP142-PD-L1 negativity was observed (p = 0.076). Conclusions: Identical usage of staining antibody is the fundament of further comparisons and deeper investigations. The FDA-approved SP263 and 22C3 assays with fixed reagent, machine and protocol may perform more effective and repeatable than LDTs such as the E1L3N method. In addition to the different staining utility among PD-L1 antibodies indicated by previous studies, we further provide insights into the dissimilar genomic correlates of stained PD-L1 by using different PD-L1 quantifying techniques.
Robot-assisted supratrigonal cystectomy and augmentation cystoplasty for neurological bladder in adults: Comparison of extracorporeal vs. intracorporeal diversion
Authors: B. Peyronnet, P. Lecoanet, A. Mellouki, J. Hascoet, B. Tibi, M. Durand, G. Verhoest, K. Bensalah, Y. Allahal, A. Manunta, I. Bentellis
Journal: European Urology (2022)
Physician awareness of immune-related adverse events from checkpoint inhibitors.
Authors: Ahmed Bilal Khalid, Shadia Ibrahim Jalal, Greg Andrew Durm
Journal: Journal of Clinical Oncology (2022)

6571 Background: Immune checkpoint inhibitors (ICIs) have been one of the most significant developments in Oncology over the last decade. Despite being very effective for certain patient subsets, they have a unique side effect profile different from conventional chemotherapy that can manifest as immune-related adverse events (IRAEs). With increasing ICI use, clinicians will increasingly encounter these adverse events and thus, adequate knowledge on recognition and management of IRAEs is very important. Methods: To assess physician knowledge on IRAEs of ICIs, an online survey was administered to resident physicians in internal medicine (IM), emergency medicine (EM) and family medicine (FM) as well as to faculty physicians in IM, and FM at 3 tertiary care hospitals in Indiana. Results: We sent the survey to 413 physicians out of which 155 responded with a response rate of 38%. Out of 155 physicians, 110 were residents and 45 were faculty (27 hospitalists and 17 primary care physicians). Pembrolizumab was identified as a checkpoint inhibitor correctly by 79% of physicians, nivolumab by 64% and ipilimumab by 55%. Twenty-five percent of physicians incorrectly believed infliximab and adalimumab were ICIs. Most physicians (93%) were able to identify the gastrointestinal tract as an IRAE site whereas only 57% and 67% were able to identify cardiovascular and renal systems as an IRAE site, respectively. Fifty-nine percent of physicians believed steroids negatively affect efficacy of ICIs and should be used with caution to treat IRAEs. Sixty-five percent of physicians incorrectly thought endocrinopathies due to IRAEs are usually reversible. Most physicians (79%) believed IRAEs most commonly manifest in the first 6 months of treatment. Forty-five percent of FM residents considered antibiotics as the mainstay of treatment in ICI associated immune mediated colitis; this was significantly different from EM (15%) and IM (8%) residents(p = 0.0004). When comparing between residency programs, on a scale of 0-100, IM residents felt significantly more comfortable identifying IRAEs secondary to ICIs (27.1±24.2) when compared to EM (12.2±12.7) and FM residents (9.4±13.8; p = 0.0009). There was no significant difference among IM (19.8±20.1), EM (11.9±13.6), and FM residents (11.6±18.9; p = 0.11) when comparing how comfortable they were in treating IRAEs. When asked what the best way would be to learn about IRAEs, 36% chose printed material and algorithms, 30% picked online teaching module and 30% chose one time in-person lecture from an Oncologist. Conclusions: Resident and faculty physicians in multiple specialties are not comfortable in the management and treatment of IRAEs due to ICIs. Given that most of these physicians are usually the first point of contact with patients, physician education on identification and treatment of IRAEs is needed. Early detection of these toxicities is critical for their resolution.
Detection of early-stage breast cancer in women by plasma lipidomic profiling.
Authors: Cheka Kehelpannala, Dana Pascovici, Desmond Li, Kerry Heffernan, Gillian Lamoury, Amani M. Batarseh
Journal: Journal of Clinical Oncology (2022)

554 Background: Early detection of breast cancer provides the best opportunity for cure. Mammography is the benchmark for screening, but suffers technical, logistic, and diagnostic limitations. An effective and accurate blood test to detect early stages of the disease should increase the screening detection rate for breast cancer. We conducted a series of lipidomic studies in early-stage breast cancer patients and combined the datasets via a machine learning driven analysis to test if plasma lipidomic profiles can detect breast cancer. Methods: Blood samples were collected from women with stage 0-IV breast cancer (4 separate cohorts) with age and BMI matched breast cancer-free controls. Lipids from plasma enriched extracellular vesicles were extracted and analysed by high resolution accurate mass LC-MS. A commercially available software was used to annotate and quantify &gt;400 manually curated lipid species. Following variable selection, a lipid signature was identified capable of distinguishing breast cancer samples from control. Results: Plasma samples from women with breast cancer were distinguished from controls with an average cross-validated accuracy of 0.81, and average AUC of 0.84 across 4 cohorts (Table 1). An optimised cross-cohort subset of early-stage IDC, DCIS and ILC were differentiated from controls with a cross-validated AUC of 0.90, sensitivity of 0.88 and specificity of 0.82 (201 early-stage breast cancer, 199 controls) (Table 1). For this optimised cohort our test achieved a sensitivity of 0.71 at a prescribed specificity of 0.90, or equivalently a sensitivity of 0.89 at a prescribed specificity of 0.80. Conclusions: Our study demonstrates the high sensitivity and specificity of a lipid biomarker signature with potential for early detection of breast cancer. Ongoing studies will prospectively compare the lipid-biomarker based test against mammographic and pathological diagnosis. [Table: see text]
Characterization of remote second-opinion oncology patients and associated changes in management.
Authors: Aadit P Shah, Siyu Shi, Sumit Shah
Journal: Journal of Clinical Oncology (2022)

e18563 Background: The utilization of virtual second opinions in oncology has increased considerably in the last decade, driven by the increased complexity of care and desire for expert opinion, improved technologies in telemedicine, and the acceleration of virtual services due to the Covid-19 pandemic. Therefore, it is important to further understand the patient populations that currently use virtual second opinion programs and to measure their effectiveness. Virtual second opinion programs provide a platform for patients to submit their medical history and questions regarding their condition to remote specialists who then render their opinions on diagnosis and management. Currently there is a paucity of research on the types of patient populations that seek second opinions and the outcomes of these rendered opinions. Here we describe the patient characteristics and changes in management associated with utilization of a virtual second opinion service at an academic medical center. Methods: In this IRB-approved retrospective review, we identified 657 cancer patients that utilized a virtual digital health platform to engage in second opinions at Stanford Healthcare. Patient demographics, cancer staging, site of origin, and prior therapeutic and surgical history were collected. Physician opinions rendered were self-classified into “major change in treatment”, “minor change in treatment”, or “no change in treatment.”. Results: The majority of patients who utilized the virtual second-opinion platform had a diagnosis late-stage cancer (with 77.2% at Stage III or IV). Breast cancer was the most common primary tumor site (24.7% of patients) followed by GI (21.9%) and GU malignancies (14.0%). Patients diagnosed with dermatological (4.4%), head and neck (3.3%), and neurological (3.2%) malignancies were least common. Physicians providing the virtual second-opinion were primarily medical oncologists (67.6%), followed by gynecologists (6.8%), urologists (5.2%), radiation oncologists (5.0%), and surgical oncologists (4.4%). Physicians self-reported that in more than half of cases reviewed (53.8%) a minor or major treatment change was recommended. Conclusions: This study showed that patients access second opinion platforms at late stage of cancer disease progression. With treatment changes recommended for more than half of the cases, virtual second opinion programs can potentially have a significant impact on cancer care. Patient satisfaction and clinical outcomes from virtual second opinion programs is an area of on-going research.[Table: see text]
Increasing colorectal screenings with navigation at federally qualified health centers.
Authors: NaSheema Anderson
Journal: Journal of Clinical Oncology (2022)

e18566 Background: From 2017 to 2019 there were a total of 423 federally qualified health center colonoscopy referrals (FQHC's) and only 81 (19%) patients followed through and had colonoscopies completed, identifying a significant gap in cancer care within an at risk populations. Methods: The Community Outreach team used a team based problem solving tools and data analytics to increase the number of patients who received colon screenings from FQHC’s. The team held brief, weekly huddles using a variety of continuous improvement tools to identify possible causes of the problem. The team identified 14 potential causes of the 19% gap in FQHC referrals to colonoscopy screenings. The potential causes were analyzed and 4 were identified as the root cause and grouped by common themes into the following opportunities for improvement: Poor engagement with FQHC's. Lack of knowledge on FQHC healthcare effectiveness data and information sets. No standardized workflow for FQHC referrals within the navigation process. Inefficient process for filling the number of screening appointment slots. After identifying the key potential causes, the team developed a task list with countermeasures for improvement and met weekly until the tasks were completed. Through root cause analysis the following key countermeasures were identified: Countermeasure 1: Increased engagement through weekly calls and monthly in person meetings at FQHC's. Countermeasure 2: Developed a quarterly newsletter for FQHC's to review colonoscopy referrals and completed screenings. Countermeasure 3: Developed and implemented a standardized process flow for receiving referrals from FQHC's. Countermeasure 4: Worked with the analytics team to create a dashboard to analyze the real time referrals and completed screenings along with sending e-mail notifications to the navigation program manager providing daily visual management of the number of new patient referrals from FQHC's. Results: After implementing the countermeasures, the community outreach team improved the number of FQHC referrals, from 423 in January of 2017 thru January 2019 to 1399 from January 2020 of December 2021.This was a 160% improvement. They also increased the number of completed colonoscopies from FQHC's from 81 in January of 2017 thru January of 2019 to 328 in January of 2020 thru December of 2021. This was a 200% improvement. The completed screening rate is 23% up from 18%. Conclusions: This project demonstrates the value of utilizing problem solving, visual management and data analytics for continuous quality improvement projects related to patient care. Cross-disciplinary collaboration should be explored with the use of visual tools and other resources to facilitate communication that is understood by all disciplines. The use of patient navigation to schedule patient screening appointments, reminders calls and resolved barriers improved no show rates.
Combined noradrenergic plus antimuscarinic agents for obstructive sleep apnea - A systematic review and meta-analysis of randomized controlled trials
Authors: Shiqian Zha, Haizhen Yang, Fang Yue, Qingfeng Zhang, Ke Hu
Journal: Sleep Medicine Reviews (2022)

Currently, no pharmacotherapy is routinely used for obstructive sleep apnea (OSA). Recently, combined noradrenergic plus antimuscarinic agents have been evaluated for the treatment of OSA in several trials. This systematic review and meta-analysis following PRISMA guidelines investigated the efficacy and safety of this combination drug regimen for the treatment of OSA. Seven databases were systematically screened for randomized controlled trials (RCTs) studying combined noradrenergic plus antimuscarinic agents for OSA to April 2022. Nine RCTs were identified for systematic review and five for meta-analysis. There were significant differences between OSA patients taking noradrenergic plus antimuscarinic agents and placebo with respect to sleep apnea-hypopnea index [mean difference (MD) -11.27 events/h, 95%CI (-21.69, -0.84) events/h; P = 0.03]; nadir oxygen saturation [MD 5.06%, 95% CI (2.57, 7.55)%; P < 0.0001], and arousal index [MD -8.17 events/h, 95% CI (-15.01, -1.33) events/h; P = 0.02] but not sleep efficiency. Our systematic review revealed that drug therapy modestly improved loop gain and upper airway collapsibility but decreased arousal threshold. A combination of noradrenergic and antimuscarinic agents administered orally before bedtime on one night significantly reduced OSA severity and improved OSA upper airway function. The long-term efficacy and safety of drug combinations in OSA patients now require further study.
Retrospective analysis of management and outcomes of patients with malignant biliary obstruction.
Authors: Abigail Sy Chan, Natasha Chandler, Brian Dong, Cristian Daniel Rios Perez, RuoBing Xue, Huirong Hu, Maiying Kong, Vivek R. Sharma
Journal: Journal of Clinical Oncology (2022)

e16266 Background: Malignant biliary obstruction (MBO) is commonly associated with pancreaticobiliary cancers (PBCa). It increases the risk for cholangitis, hepatic failure, and deconditioning, which delays systemic therapy. This study aims to identify predictors associated with MBO outcomes after biliary decompression. Methods: This single-center, retrospective study analyzed patients with MBO from 2016-2020 who underwent biliary drainage. Patient demographics, cancer history, intervention type, and date of last follow up were obtained. Descriptive statistics were used to summarize relevant variables. Baseline characteristics were compared using Chi squared tests. Kruskal Wallis test was used to identify whether there were significant difference among multiple groups. Results: Of the 59 patients included, mean age was 62 years and 75% had PBCa. Baseline characteristics were presented in Table. The mean survival time from MBO diagnosis was 227 days (range: 16-1446). Overall, 39% survived at the end of 6 months follow up. Of the 29 patients who received chemotherapy after decompression, they were younger (57 vs 66 years old, p = 0.004). History of prior chemotherapy was significantly associated with increased 180-day mortality (OR 0.75, CI 0.58-0.97, p = 0.033). There were no differences based on sex, race, primary cancer, stage, intervention type or bilirubin levels in chemotherapy initiation or 6-month survival. In those with MBO as initial presentation of cancer, they were older, had pancreatic or biliary cancer, non-metastatic disease, unresected primary tumors, treatment-naïve, and no survival difference compared to later MBO presentation. Conclusions: Diagnosis of MBO is significantly associated with mortality (61% at 6-months) in our patient population, similar to historical controls of 40-60%. This data suggests that younger patients and those treatment naïve were associated with receipt of subsequent therapy and better 6-month survival, respectively.[Table: see text]
Clinical outcome and characteristics of Turkish breast cancer patients during SARS-Cov-2 pandemic: Single center experience.
Authors: Aysun Isıklar, Aykut Soyder, Ozge Gumusay, Gul Basaran
Journal: Journal of Clinical Oncology (2022)

e13049 Background: COVID-19 pandemic has placed an unprecedented burden on health care system. Patients with cancer are reported to have a higher risk of infection and a more complicated COVID-19 course. Breast cancer (BC) is the most common cancer in women in Turkey. We aimed to evaluate the clinical outcome of breast cancer patients who had a diagnosis of COVID-19. Methods: Medical records of breast cancer patients who had COVID-19 between July 2020-2021 at our center were retrospectively rewieved. We recorded pathological, clinical, treatment characteristics, and the clinical outcome of COVID-19 infection. Results: A total 82 breast cancer (BC) patients had COVID-19 between July 2020-2021. All patients were female, with a median age of 49 (43-64 years). Eighty-five % of all patients had early and 14.6% had advanced stage BC. COVID-19 had a mild clinical course in 73%, hospitalization was required in 27% of patients. Twenty-five patients who required hospitalization were discharged. Three (3,6%) patients who had heavily pretreated metastatic breast cancer, required ICU and died due to COVID-19. Metastatic disease (p 0.002) and chemotherapy within 7 days of COVID-19 diagnosis (p = 0.024) have been associated with increased mortality. Conclusions: In our breast cancer cohort, most patients had a mild COVID-19 course. Advanced disease and chemotherapy within 7 days of diagnosis were the two risk factors for increased mortality.